Hilary Dumitrescu knew what postpartum depression was before she became a mom – she had heard stories of famous mothers who battled the illness and had a sister who suffered from its effects – but none of that knowledge prepared her for what she experienced after the birth of her first child.

“I thought having the baby would be the hardest part,” she said. “I figured once she was safely out that I’d be an old pro – wrong. The next three months were a mishmash of intense, terrifying love, and complete physical and psychological misery. Oh, and sleep deprivation.”

Dumitrescu is far from alone in her experience. The third leading cause of maternal death in this country, an estimated one out of six women will experience some degree of postpartum depression, according to Jennifer Ungarwulff – a therapist at Mother Heart Counseling in Silverton.

“All the life change, the huge role shift, that can just shatter your world,” she explained. “I think it’s really important for women who are having any sort of mild depression to come in.”

Audry Van Houweling – a Psychiatric Nurse Practitioner specializing in women and girls at She Soars Psychiatry in Silverton – agrees that diagnosis and treatment is incredibly important. She sees healthy mothers as the backbone of the community and worries that – if unaddressed – postpartum depression can develop into ongoing sadness, isolation and despair for the sufferer leading to very real impacts on the health and development of the infant.

But determining if a woman is suffering from depression can be difficult. Often the woman herself may not recognize the symptoms, which can manifest in a variety of ways including: irritability, feeling overwhelmed, tearfulness, hopelessness, negative self-judgment and a hyper-focus on the baby.

For Dumitrescu, her depression included a combination of all of these symptoms.

“There was the immediate reaction of being constantly anxious about her safety and comfort,” she said. “I was crying all the time. I was terrified to put the baby down – couldn’t sleep unless she was on me or my husband had her. I couldn’t leave her with anyone, not even my parents or sisters. I was just miserable.”

The cause of feelings like these – depression, inadequacy and anxiety – is not entirely known but there are theories. Genetic predisposition – including a family history of bi-polar disorder, depression or anxiety – as well as psychosocial influences – such as a lack of support system, stress and sleep deprivation – can all be contributing factors, according to Ungarwulff.

“Postpartum depression is a really normal reaction to a really hard situation,” she said.

Added to the risk factors are the very real physiological and hormonal changes that occur during pregnancy and childbirth, ones that can exacerbate or even cause illnesses like hypothyroidism and autoimmune disorders.

“There are very real physiological changes that occur during and post pregnancy,” Van Houweling said. “Following birth, hormone levels drop dramatically, which also directly cause fluctuations in neurotransmitters such as serotonin, dopamine, and norepinephrine that can contribute to depressive symptoms.”

Ungarwulff noted that the symptoms of depression generally occur any time between pregnancy and a year after the birth but some women may still feel the effects for years and can even experience a continuing depression from one pregnancy to the next. That overlap is what Silverton resident and mother of two Brianna Wolterman experienced.

“Postpartum was so difficult,” she remembered. “Nothing about breastfeeding went right. I was determined that that’s what we would do so I used donor milk and a Supplemental Nursing System until my supply was enough for him. It was devastating to feel like a failure. When I got pregnant again, I was never really over my PPD and spent the entire pregnancy loving a baby I was carrying but really struggling with depression the whole time.”

Wolterman explained that she never sought treatment for her depression and instead made excuses for how she felt, telling herself she was “fine.” According to Ungarwulff this kind of denial is common and can make it difficult to recognize which women are suffering.

“It’s the idea that being a mom should be easy – that it’s not really work – it sort of undermines the value of mothers,” she said. “It’s part of that ‘women need to be perfect’ in the world. They’re not allowed to be imperfect or struggling.”

Ungarwulff thinks the solution lies in community support for families – and mothers in particular.

“People don’t live in the same city or state as their relatives,” she said. “A lot of people don’t get paid maternity leave. There’s no support for childcare and preschool culturally. We’re not supporting you – there’s no support for you.”

Dumitrescu agrees and suggests one method communities can aid new mothers is by not waiting until they ask for help. Instead, she recommends banding together in support and commandeering daily chores like house cleaning, laundry and cooking dinner.

“Because if you ask her, ‘what can I do?’ you’re just adding another decision to five billion decisions she’s already making,” she said.

Ungarwulff also suggests women make time for self-care. Although it can seem overwhelming to a new mother; good nutrition, 25 to 30 minutes of mild to moderate exercise every day, aromatherapy, sad lights and support groups can all be helpful ways of boosting both physical and mental health.

“I know what it’s like, and it’s not easy,” she said. “Everybody feels guilty when they take time for themselves, but it doesn’t have to be super extreme. It’s always good to take care of yourself.”

Ungarwulff also urges women who are newly pregnant or thinking about becoming pregnant to be proactive in discussing their personal risk factors for postpartum depression with their doctor, midwife or a mental healthcare provider and to come up with a preliminary plan.

“The earlier you go in the better,” she said.

Van Houweling also advised mothers to treat themselves and each other with compassion and to avoid the pitfalls of expecting perfection.

“I think there is a lot of comparison, judgment, and continued stigma that is made even more immediate by social media,” she said. “Women can be hard on each other. Making room for authenticity and admission of struggle is so important in order that women can feel truly supported.”